Purpose: Cannabis products and routes of administration (e.g., smoking, vaping) vary. Harm perceptions are associated with use, yet little research examines these across routes of administration. We compared harm perceptions of cannabis smoking versus cannabis vaping and correlates among young people across England, Canada, and the US.

Methods: Youth (ages 16-19; n = 37,761) and young adults (20-29; n = 8,762) completed the ITC Youth & Young Adult Tobacco and Vaping Survey (2022-2024). Relative perceived harms of daily cannabis smoking versus daily cannabis vaping were assessed; adjusted regressions examined differences by country, mental health, nicotine smoking/vaping, and cannabis use.

Results: Overall, 10.4% of youth and 11.8% of young adults perceived smoking cannabis as more harmful than vaping cannabis. Odds of perceiving smoking cannabis as more harmful than vaping cannabis were higher in England versus the US (youth: OR = 1.89, 95%CI:1.69-2.13, p < 0.001; young adults OR = 1.47, CI:1.14-1.92, p = 0.004) and versus Canada among youth (OR = 1.47, CI:1.35-1.61, p < 0.001), among youth with moderate-to-high mental health symptoms (vs. no/low symptoms, OR = 1.23, CI:1.13-1.35, p < 0.001) and youth who smoked and/or vaped nicotine or formerly used cannabis (vs. never used, all p < 0.05). Among young adults, perceptions did not vary by mental health or nicotine/cannabis use.

Background: As oral nicotine pouches (ONPs) have gained popularity in the US, little is known from nationally representative data about who uses them and how they are being used.

Objectives: To examine tobacco use and sociodemographic correlates of ONP use, use frequency and flavour use among US adults.

Methods: Data were drawn from the 2022-2023 Tobacco Use Supplement to the Current Population Survey (n=1 57 485). Weighted logistic regression models were used to identify predictors of (1) current ONP use, (2) daily versus non-daily ONP use and (3) flavoured versus unflavoured ONP use.

Results: The odds of current ONP use were higher among younger adults, males, non-Hispanic Whites, individuals with higher income and those who had ever used cigarettes, e-cigarettes or smokeless tobacco (SLT). People who currently use cigarettes, e-cigarettes or SLT had lower odds of daily (vs non-daily) ONP use, whereas people with a history of cigarette use who do not currently smoke had higher odds. Males, younger adults and people with a history of SLT use who do not currently use SLT were more likely to use flavoured ONPs.

Conclusions: ONP use was common among individuals with current and prior tobacco use which may be consistent with alternative nicotine use. However, a small proportion of ONP users reported no prior use of other tobacco products, highlighting the need for continued research on nicotine uptake through ONPs among tobacco-naïve populations, particularly among young adults. In addition, the prevalence of co-use with other tobacco products may limit potential public health benefits.

Background: ZYN brand and non-tobacco-flavoured products capture most of the US nicotine pouch market. Evidence of which nicotine pouch flavours and brands US youth use is critical for informing youth regulatory protections, but currently lacking.

Methods: We analysed data from adolescents reporting lifetime nicotine pouch use in the 2025 Monitoring the Future study, a nationally representative, in-school, cross-sectional annual survey of US 8th-grade, 10th-grade and 12th-grade students. Prevalences of nicotine pouch flavours and brands adolescents reported using most often were estimated in the overall sample and stratified by demographic characteristics and past-30-day pouch use patterns.

Results: Among 472 youth who used nicotine pouches in their lifetime, 97.0% (95% CI 94.6% to 98.4%) reported using nicotine pouches with a non-tobacco flavour most often; non-tobacco flavoured pouch use prevalence exceeded 93% across all demographic and past-30-day pouch use-frequency categories studied. Mint was the most commonly reported flavour used (58.6%), followed by fruit (16.0%); use of original/unflavoured pouches was rare (3.0%). ZYN was the most common brand used, reported by 79.7% (95% CI 74.1% to 84.4%) of youth. Use prevalence of ZYN versus other pouch brands was lower among non-Hispanic Black versus non-Hispanic White, but did not vary by sex, grade, population density or pouch use frequency.

Conclusions: Among US adolescents reporting lifetime use of nicotine pouches in 2025, use of non-tobacco flavoured pouch products was nearly universal and ZYN was the predominant brand used. Prioritising regulatory policies on flavoured pouches, especially ZYN brand products, merits consideration to reduce youth nicotine pouch use.

Background: Arab Americans are one of the fastest-growing immigrant populations in the United States, yet they remain largely invisible in tobacco surveillance and prevention efforts due to their classification as "White" in national data. Despite evidence of elevated tobacco use and chronic disease burden, limited research has examined how cultural, psychological, and social factors shape tobacco-related health risks in this community.

Objectives: This study examined associations between ethnic identity, tobacco use, and health outcomes (self-rated health, chronic disease diagnosis) among Arab American adults, and tested whether ethnic identity moderated the association between tobacco use and health outcomes.

Methods: In a cross-sectional study, a convenience sample of 112 Arab American adults residing in Central California completed a survey assessing ethnic identity, tobacco use, and health. Ethnic identity was measured using an abbreviated, Arabic-translated adaptation of Phinney's Multigroup Ethnic Identity Measure. Tobacco use was categorized as non-use, single-product use, or multi-product use. Multivariable regression models assessed associations and potential moderating effects of ethnic identity on health outcomes.

Results: Over 48% of study participants reported current use, defined as at least some use or more, of at least one tobacco or nicotine product, including cigarettes, e-cigarettes (which may contain synthetic rather than tobacco-derived nicotine), and hookah. Higher ethnic identity scores were associated with significantly lower odds of tobacco use (adjusted OR = 0.35, 95% CI: 0.15-0.83). Single-product users had 75% lower odds of reporting better self-rated health compared to non-users (OR = 0.25, 95% CI: 0.07-0.96). No significant associations were found for multi-product use or chronic disease in adjusted models, and ethnic identity did not significantly moderate associations with health outcomes.

Conclusion: Ethnic identity is associated with lower tobacco use among Arab Americans, though its protective effects on health outcomes remain less clear. These findings underscore the need to move beyond acculturation-based frameworks and incorporate identity-informed, culturally responsive approaches to tobacco control in marginalized immigrant communities.

Background: Acute electronic cigarette (E-cigarette) use has shown adverse cardiorespiratory impacts similar to conventional cigarette (C-cigarette) smoking; however, its early effects remain unclear.

Objectives: We aimed to examine the early effects of E-cigarette use on systemic vascular function, cardiorespiratory responses to exercise, and exertional symptoms in young adults.

Methods: 75 healthy active young adults (18–30 years), divided into three age- and sex-matched groups (E-cigarette users, C-cigarette smokers, never-smoker controls; n=25 each, E-cigarette use or smoking duration ≥18 months), underwent an incremental cycle exercise test with standard metabolic, cardiorespiratory, blood lactate and sensory measurements. Brachial artery flow-mediated dilatation (FMD) was assessed using Doppler ultrasound. Blood samples were collected to assess vascular inflammatory markers.

Results: Cotinine (nicotine metabolite) levels were not different between E-cigarette users and C-cigarette smokers (80.7±33.0 versus 65.5±27.6 pg·ml⁻¹, p=0.2). At peak exercise, both E-cigarette users and C-cigarette smokers had lower exercise capacity, oxygen uptake, and ventilation compared to controls (182±31, 178±27 versus 219±43 watts; 35.1±6.4, 35.1±5.3 versus 41.2±5.9 mL·kg⁻¹·min⁻¹; 97.8±24.7, 98.9±21.6 versus 116.1±29.8 L·min⁻¹, respectively; all p<0.05). Furthermore, E-cigarette users and C-cigarette smokers demonstrated decreased exercise ventilatory efficiency, with higher ventilation, blood lactate, dyspnoea ratings, and leg discomfort during submaximal exercise compared to controls. E-cigarette users and C-cigarette smokers showed lower FMD compared to never-smokers (4.7±3.0, 4.5±2.9 versus 8.1±3.5%, p<0.05), which was inversely associated with vascular cell adhesion molecule-1 and thrombospondin-2.

Conclusion: E-cigarette use and C-cigarette smoking were both associated with early detrimental effects on exercise capacity, ventilatory efficiency, systemic vascular function, and amplified exertional symptoms.

Introduction: Rural communities in the United States experience higher tobacco use and worse tobacco-related health outcomes than urban areas, with disparities increasingly extending to electronic nicotine delivery systems (ENDS). Little is known about rural-urban differences in ENDS use across detailed age groups.

Methods: We analyzed data from the 2022-2023 Tobacco Use Supplement to the Current Population Survey (TUS-CPS), a nationally representative survey of U.S. adults (≥18 years). Respondents were categorized into four age groups (18-24, 25-44, 45-64, ≥65). Rural-urban residence was defined using metropolitan status. Weighted prevalence estimate of lifetime, former, and current ENDS use were calculated by age group and rural-urban residence, and gender-adjusted contrasts were estimated using survey-weighted marginal standardization.

Results: Lifetime, former, and current ENDS use were 9.6%, 6.6%, and 3.0%, respectively. Lifetime and current ENDS use were higher in rural than urban areas across most age groups, with the largest differences observed among adults aged 25-44 and 45-64 (current use PRs of 1.29 and 1.44, respectively). YAs (18-24) in rural areas had the highest prevalence (lifetime: 19.5%; current: 10.5%). Among lifetime users, adults aged 18-24 and 25-44 in rural areas were more likely to report current use than their counterparts in urban areas (18-24: 53.8% vs. 44.6%; 25-44: 35.2% vs. 29.5%). Former use was significantly higher in rural areas overall and among adults aged 25-44 and 45-64, but not among adults aged 18-24 or ≥65.

Conclusions: These patterns of ENDS use underscore the need for age-targeted ENDS prevention and cessation interventions in rural populations.

Introduction: The US Food and Drug Administration has proposed a product standard that would reduce the nicotine content and addictiveness of cigarettes. It is unclear what impact this would have on economic outcomes or priority populations who are disproportionately harmed by tobacco use, such as people with major depression (MD). We evaluated the long-term health and economic impacts of a nicotine product standard for the US population by MD status.

Methods: We developed and calibrated a microsimulation model using the National Survey on Drug Use and Health 2005-2023 data on smoking, e-cigarette use and MD episodes. We used this model to simulate a nicotine product standard from 2027 to 2100 based on the FDA's expert elicitation estimates of the policy's anticipated effects on smoking and vaping.

Results: Under the proposed product standard, smoking is projected to decline to <1% for people with and without MD by 2040, resulting in 1.6 million premature deaths averted by 2100 and 8.0 million fewer cases of MD. Longer life expectancies under the policy are projected to increase medical costs by US$336 billion, while also increasing worker productivity by US$298 billion and consumer spending by US$1.3 trillion.

Conclusions: Timely implementation of a nicotine reduction strategy, either through a federal product standard or state-level sales restrictions, is cost-effective and could prevent millions of premature deaths while reducing smoking disparities by MD status.

Introduction: The Food and Drug Administration proposed a rule to ban the sale of menthol cigarettes, but recently withdrew the proposal. This study uses simulation modeling to estimate the impact of a national menthol cigarette ban on tobacco use, life expectancy, and lung cancer.

Methods: We used the Tobacco Use Individual-level Simulation and Tracking (TwIST) Model, a validated microsimulation model of tobacco use in the US adult population. The simulated population and model parameter estimates are primarily informed by data from the Population Assessment of Tobacco and Health Study. We used findings from a published meta-analysis to inform estimates of the impact of a menthol ban on tobacco use in the model.

Results: Ten years after a menthol ban, the model projects a 38.5% reduction in tobacco use prevalence among adults. Declines are even greater in the non-Hispanic Black population (70.4% reduction) and among individuals living in poverty (46.0% reduction). Among a cohort of adults, individual life expectancy is projected to increase by 73 days, on average. Among the non-Hispanic Black population and individuals living in poverty, life expectancy will increase by 193 days and 183 days, respectively. In the cohort, 1-year incidence of lung cancer is estimated to decline by 14.4% in the general population, 32.4% among non-Hispanic Black adults, and 22.1% among individuals living in poverty.

Conclusions: A menthol ban would reduce tobacco use and lung cancer rates, while increasing life expectancy. The greatest benefits are expected among non-Hispanic Black individuals and people living in poverty.

Importance: The US Food and Drug Administration (FDA) is pursuing a low-nicotine product standard for cigarettes and other combusted tobacco. Very low nicotine content cigarettes (VLNCs) contain approximately 95% less nicotine than standard cigarettes. A key concern is that people who smoke may increase their smoking to compensate for the reduced nicotine levels, which would be a major unintended consequence of the regulation.

Objective: To examine whether people who smoke increase their smoking behavior and/or smoke exposure when smoking VLNCs for extended periods.

Data sources: A comprehensive search was performed across multiple databases (eg, PubMed Medline, Embase, Web of Science, Cochrane Library, and CINAHL) on July 5, 2024, to identify randomized clinical trials (RCTs) evaluating VLNCs.

Study selection: Eligible RCTs reported treatment conditions comprising smoking VLNCs for 3- to 20-week periods. Control conditions varied but typically included smoking normal nicotine content cigarettes (NNCs).

Data extraction and synthesis: This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Two investigators performed the data extraction.

Main outcomes and measures: Outcomes included the total number of cigarettes smoked per day and exhaled breath carbon monoxide (CO) exposure at the end of the intervention.

Results: Seventeen RCTs (16 from the US and 1 from New Zealand) published between 2010 and 2024 met inclusion criteria, representing 5500 adolescents and adults who smoked cigarettes daily or nondaily, with or without quit interest. The pooled meta-analysis included a subset of 2454 participants from 7 US trials. No trials reported increases in the mean number of cigarettes smoked per day or CO exposure at the end of the intervention among participants assigned to VLNCs vs NNCs. It was estimated that 0.8% of participants could expect an increase in smoking, with a maximum expected increase of 3.3 cigarettes smoked per day, and 8.1% could expect an increase in CO exposure, with a maximum expected increase of 4.2 parts per million 6 weeks after randomization if assigned VLNCs vs NNCs.

Introduction: Remote tobacco cessation trials can expand access, yet enrollment, adherence, and retention remain challenging. This study aimed to identify individual- and neighborhood-level factors associated with enrollment, adherence, and retention in a two-arm, remotely delivered tobacco cessation randomized controlled trial (RCT). We conducted a secondary analysis of data from RCT NCT05277831.

Methods: Adults who smoke were recruited between October 2022 and July 2024 through quitlines, recruiting firms, and community outreach conducted in Arizona, New York, and West Virginia. Participants were block-randomized to a behavioral cessation intervention or behavioral plus guided imagery intervention. Data were collected using online, self-reported questionnaires. Outcomes included enrollment (Session 1 completion), adherence (≥4/6 sessions), and 3 month retention, using multivariable logistic regression estimated adjusted odds ratios (AORs) for demographic, clinical, and neighborhood disadvantage covariates.

Results: Of 1595 randomized participants, 1209 enrolled (75.8%), 914 (75.6%) were adherent, and 1046(86.5%) were retained at 3 months. The sample (mean age 50 years) was predominantly female (65%) and White (77%); about 35% had high school or lower education. Enrollment was lower among males (AOR=0.76; 95% CI: 0.60-0.97, p=0.03) those with lower education (AOR=0.74; 95% CI: 0.57-0.96, p=0.03), and those from more disadvantaged neighborhoods (AOR=0.99; 95% CI: 0.98-0.99, p=0.02). Adherence was higher with older age (AOR=1.02; 95% CI: 1.01-1.03, p=0.003), but lower with multiple household smokers (AOR=0.90; 95% CI: 0.82-1.00, p=0.05). Non-English primary language (AOR=0.36; 95% CI: 0.14-0.92, p=0.03), having more than one household smoker (AOR=0.88; 95% CI: 0.79-0.98, p=0.02), lack of a high school education (AOR=0.39; 95% CI: 0.23-0.65, p<0.001), and substance use (AOR=0.40; 95% CI: 0.2-0.81, p=0.01) were all associated with lower retention.

Conclusions: Sociodemographic factors influenced enrollment, adherence, and retention, highlighting the importance of continued research to better understand and address engagement challenges in remotely delivered cessation studies.

Purpose: Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet tobacco treatment has not been integrated into community oncology settings. We conducted a trial of a virtual sustained tobacco treatment intervention across community oncology settings nationwide.

Methods: This randomized controlled trial compared the effectiveness of sustained telehealth counseling plus medication (virtual sustained treatment [VST]) to referral to the National Cancer Institute (NCI) quitline (enhanced usual care [EUC]) in assisting patients recently diagnosed with cancer to quit smoking. The VST group received up to 11 synchronous telehealth sessions (four weekly, four biweekly, three monthly) of motivational counseling and up to 12 weeks of free nicotine replacement therapy (NRT).

Results: From August 2019 to December 2022, 306 English- and Spanish-speaking patients were randomly assigned from 37 NCI Community Oncology Research Program community sites. Participants were 70.9% female; 86.3% was White; the median age was 57 years; and 45.4% had non-smoking-related tumors. A total of 221 of 302 (73.2%) smoked within 30 minutes of waking. Six-month, 7-day point abstinence rates were 28.4% (42 of 148) in the VST group versus 14.7% (21 of 143) in the EUC group; there were no significant treatment moderators. A total of 80.8% (126 of 156) of VST participants engaged in counseling, and 85.7% (108 of 126) were dispensed NRT. Participants who completed >8 sessions versus <5 sessions were more likely to quit; P = .005. VST participants were almost four times more likely to report guideline-concordant smoking cessation medication use. Continuous abstinence and significant reduction rates at 6 months were higher in the VST group. The incremental cost per quit was $7,724 in US dollars.

Introduction: Certain Asian American subgroups have higher smoking rates than the general population, contributing to preventable mortality. This study evaluated the implementation and outcomes of a proactive tobacco treatment outreach strategy at Paul Hom Asian Clinic (PHAC), a student-run free clinic serving Asian Americans in Sacramento, California.

Methods: We conducted a retrospective observational study of all active PHAC patients from August 2020 to June 2021. Volunteers used the Ask, Advise, Connect framework, which involves assessing tobacco use, advising smokers to quit, and referring them to cessation resources via the Asian Smokers' Quitline (ASQ). Outreach calls were made in patients' preferred languages to collect demographics, smoking status, and referral acceptance. The ASQ provided outcomes for referred patients, including counseling completion, unreachable status, or refusal. Descriptive statistics and exploratory logistic regression identified factors associated with successful contact.

Results: Among 1733 patients, 194 (11.2%) had a history of tobacco use or exposure, including 162 current smokers, 27 former smokers, and 5 passive smokers, most being non-English speakers. Proactive outreach reached 23.2% of patients, with a 24.4% referral acceptance rate. Of those referred, 8 out of 11 completed counseling, 2 were unreachable, and 1 declined. Logistic regression indicated that increasing age was associated with lower odds of contact, particularly for patients aged ≥50 years. Sex and language were not significant predictors.

Conclusions: Proactive outreach by student volunteers shows promise for promoting tobacco cessation among Asian American patients. Despite barriers, nearly one-quarter accepted referral, with most engaging in counseling. These findings highlight the potential for student-run clinics to deliver culturally and linguistically tailored interventions to underserved populations.

Purpose: We evaluated the reach, treatment selection, and effectiveness of a population-based, opt-out smoking cessation outreach program, No Smoker Left Behind, implemented in a socioeconomically and racially diverse cancer patient population.

Methods: Patients seeking oncology care at the University of Chicago Comprehensive Cancer Center between 2019 and 2024 were screened for smoking status as documented in the electronic health record. Adults age 18 years and older categorized as currently smoking (past month) were systematically contacted via interactive voice response phone calls, texts, and emails for up to 6 months. They were offered several cessation treatment options, including medication and counseling referrals (ie, group program, quitline, and text message program). Program involvement and cessation outcomes were compared by cancer type (ie, smoking- or non-smoking-related) and race. A cost-outcome analysis was also conducted.

Results: Of 37,478 patients with cancer, 3,706 (9.9%) were deemed eligible and contacted, of whom 57.0% were male, 46.6% Black, and 63.8% publicly insured. Of those selecting cessation treatments (n = 1,089), most self-selected both medication and counseling (70.6%), with 873 receiving referrals or connection to cessation support. Among patients who completed day 180 follow-up (37.5% of those receiving referrals), 16.2% (53/327) self-reported ≥8-day abstinence. Patients with smoking-related cancers had higher abstinence rates than patients with non-smoking-related cancers (23.7% v 14.7%). Black patients had higher program involvement and treatment referral rates, but significantly lower smoking abstinence compared with White patients (14.4% v 25.7%). Costs-per-patient referred to treatment were $415 US dollars (USD) and costs-per-quit were $6,067 USD.

Conclusion: Population-based, proactive opt-out outreach programs provide a feasible approach for offering multiple cessation treatment options that allow for patient preference and customization to optimize treatment accessibility. As health care systems expand access to tobacco cessation as part of cancer care, implementing resource-efficient models will become increasingly important.

Introduction: Lung cancer screening (LCS) is an optimal time to offer tobacco treatment to adults who smoke, but many cannot quit even with treatment. Replacing combustible cigarettes (CC) with e-cigarettes (EC) could be a harm reduction approach, but few older adults use EC. No study has examined EC harm reduction potential among individuals undergoing LCS.

Methods: In a pilot mixed-methods single-arm clinical trial, we assessed the feasibility and short-term effects of providing EC to older adults not planning to quit after completing a smoking cessation trial at LCS. Participants were asked to use tobacco-flavored NJOY Ace EC (5% nicotine) for 4 weeks. Assessments occurred at weeks 1, 2, 3, 4, and 8, with qualitative interviews at week 4. Primary outcomes were study feasibility and change in cigarettes/day (CPD) during EC provision. Secondary outcomes included breath carbon monoxide (CO) and EC use.

Results: From 9/2024-2/2025, we enrolled 15 participants (54% of eligibles; mean age = 66.1 years, 40% female); 14 (93%) completed the study. Over the 4-week EC provision, mean CPD and breath CO declined significantly (CPD = 16.9 [SD:7.2] to 10.4[SD: 7.0], P<.001; CO: 19.4[SD:11.0] to 12.3[SD: 8.5], P=.04). Mean CPD remained stable post-EC provision. At week 4, participants used EC on 5.5 (SD:2.4) days/week; 2 participants (13%) used only EC, 12 (80%) were dual users, and 1 (7%) used only CC.

Conclusions: This pilot trial showed the feasibility of recruiting older adults unable to quit smoking after LCS to use EC and suggested the short-term efficacy of EC to reduce CC consumption and CO exposure.

Implications: This pilot study demonstrates the feasibility and promising short-term effects of switching older adults who smoke and did not quit at LCS to use EC. Participants' cigarette consumption and CO exposure declined over 4 weeks of EC provision, but most participants became dual users (EC and CC). Qualitative interviews illustrated benefits and challenges of switching. The findings deserve confirmation in a larger sample, but suggest that longer EC provision and behavioral support might help this group to completely replace CC use and gain the full harm reduction benefits associated with switching to EC.

Introduction: Surveillance of nicotine/tobacco use typically examines binary use (vs. non-use) of each product in isolation, but this fails to capture product substitution and subtypes of multi-product use. The current analysis uses more temporally and behaviorally granular classifications to examine trends of electronic nicotine delivery systems (ENDS) and/or cigarette use.

Methods: Quarterly trends in cigarette and ENDS use from the National Health Interview Survey (NHIS) 2014-2024 were examined. Smoking/vaping status was defined using self-reported frequency (every day, some days, not at all) for each product, yielding nine categories including non-use. Trends were analyzed overall and by age groups (18-29, 30-44, 45-59, ≥60).

Results: Use of either product declined modestly (18% in 2014 Q1 to 16% in 2024 Q4). Exclusive smoking decreased substantially (80% to 50% of those using either product), which was largely offset by a pronounced increase in exclusive vaping (from 5% to 40%). Dual use exhibited a U-shaped pattern with an initial decline and subsequent increase. While use of either product remained stable for most age groups, age significantly moderated trends: adults aged 18-29 exhibited the steepest decline in exclusive smoking (73% to 7%), followed by adults aged 30-44 (78% to 47%) and 45-59 (84% to 72%). Conversely, exclusive smoking among adults aged ≥60 remained predominant and largely unchanged (86% to 85%).

Conclusion: A marked shift from exclusive smoking to exclusive vaping occurred from 2014-2024. This transition may represent population-level harm reduction by migration to noncombustible products, especially among younger adults, with limited change among older adults.

Implications: Population-level shifts from exclusive smoking to exclusive vaping - within an overall stable level of tobacco/nicotine product use - may indicate that noncombustible nicotine products have complemented traditional tobacco control efforts over this time period in reducing and/or preventing cigarette smoking. The balance between allowing access to lower-risk alternatives for adults who smoke and preventing uptake among non-users remains critical. The persistence of exclusive smoking among older adults highlights the need for targeted interventions for this priority population. Finally, the recent increase in dual use underscores the importance of continued surveillance, for which quarterly NHIS data can provide valuable insights.

Introduction: Vaping nicotine is the most prevalent mode of nicotine use among US youth. Research is needed to understand youth use over time, including transitions to or away from dual use. How these transitions are related to frequency of use, nicotine dependence, and biomarkers of nicotine and tobacco toxicant exposure provides key information on the public health impact of ENDS use among US youth.

Methods: Longitudinal data from Waves 4 and 5 (2016/18 - 2018/19) of the Wave 4 Biomarker Core sample (ages 12-17 at Wave 4) of the Population Assessment of Tobacco and Health (PATH) Study were used. Eight Wave 4 to 5 transitions in ENDS and combustible tobacco use were examined among youth reporting current ENDS use at Wave 4 (n=419). Past 30-day ENDS use frequency, nicotine dependence, and biomarkers of nicotine and tobacco toxicant exposure at Wave 4 and Wave 5 were compared across transition groups.

Results: Youth who maintained dual use and youth who transitioned from dual use to ENDS-only use reported the highest estimated days of ENDS use (M=22.12 days and 23.86 days, respectively) and the highest mean nicotine dependence (M=2.75 and 2.74, respectively). Those who maintained dual use had significantly greater increases in nicotine exposure (GMR=3.87; 95% CI=1.67, 8.98) and tobacco-specific nitrosamine exposure (GMR=3.53; 95% CI=2.19, 5.70) compared to youth who maintained ENDS-only use.

Conclusions: We found significant heterogeneity by transition group among US youth using ENDS. Dual use, particularly persistent dual use, represents a significant concern for the health of youth.

Introduction: Couple-based smoking cessation interventions can be more effective than individual ones in initiating and maintaining cessation behaviors, but they often require costly in-person visits. More affordable and accessible options are needed.

Methods: The aim of this study was to develop a couple-based, web-app, WeQuit, for smoking couples and to pilot-test its feasibility, acceptability, and preliminary effects. Using Family Systems theory, WeQuit was developed focusing on three relational constructs: communal coping, smoking-system fit, and ironic processes. Feasibility was evaluated by completion rates and time spent on the app. Acceptability was determined by using standardized measures of perceived usability and satisfaction with WeQuit. Preliminary effects were determined by changes in smoking-related and relational couple dynamic variables.

Results: Forty couples were invited and completed WeQuit. Nearly half of the primary smoking participants were female (n = 20, 50.0%) and Black (n = 18, 45.0%). About 77.5% (n = 31/40) and 45.0% (n = 18/ 40) completed more than half and 100% of the program, respectively. WeQuit was perceived as "very useful" (80.0 %) and "very easy to use (87.0 %). Respondents felt 'very confident developing quit plans' (80.0 %) and 'very satisfied" (87.0 %). WeQuit significantly improved positive partner support (p<.001). Participants who quit showed significant improvements in positive partner support (p<.001) and dyadic efficacy (p=.006).

Conclusions: This study reveals that the theory-guided couple-based web-app, WeQuit, holds promise for promoting smoking cessation among smoking couples. Future research will involve a large pilot trial to evaluate the effectiveness of WeQuit on smoking cessation outcomes.

Implications: This pilot study introduces WeQuit, a novel, theory-driven, couple-based web app, addressing the need for affordable and accessible alternatives to in-person smoking cessation treatment. By leveraging Family Systems theory and focusing on relational constructs, WeQuit demonstrates high feasibility and acceptability among smoking couples. The preliminary findings from forty smoking couples suggest promising effects on positive partner support and dyadic efficacy, key factors in successful cessation. This work contributes to the literature by offering a scalable, relationship-focused approach that can potentially broaden the reach of effective smoking cessation support.

Introduction: In 2019, Massachusetts enacted the nation's first comprehensive statewide restriction on flavored tobacco sales and expanded tobacco cessation coverage. This study assessed the policy's sustained effectiveness by examining trends and factors associated with tobacco use during the maintenance phase of the policy.

Methods: We conducted monthly cross-sectional surveys (April 2021 to July 2022) to assess trends of past 30-day use of cigarettes, e-cigarettes, and other tobacco products of youth (ages 13-17, N=1,858) and adults (ages 18+, past 30-day tobacco use, N=1,548), including quit attempts among adults. We compared trends in Massachusetts to four neighboring states that did not have similar statewide restrictions using generalized linear models, modeling each outcome as a function of time (one-month increments), state (Massachusetts vs. four neighboring states), and an interaction between month and state, and adjusted for demographic covariates.

Results: Analyses identified no significant differences in tobacco use trends between residents of Massachusetts and comparison states. While Massachusetts youth showed stable cigarette use and slower increases in e-cigarette use compared to steeper rises in neighboring states, these differences were not statistically significant. Among adults who currently use tobacco, monthly trends of their tobacco use and past-year quit attempts were also comparable across states.

Conclusions: Findings highlight the need for comprehensive approaches combining sales restrictions with enhanced cessation support and prevention programs to achieve sustained effects on reducing population tobacco use. We found no unintended increase in trends of cigarette use among youth or adults in response to the Massachusetts flavor restrictions versus comparison states.

Implications: This study aimed to compare trends in tobacco use for youth and adults, and quit attempts for adults in Massachusetts with those in neighboring states over a 16-month period in the maintenance period of implementation (in 2021 and 2022) of the statewide Massachusetts flavored tobacco sales restriction. We found no unintended increase in trends of cigarette use among youth or adults, and findings highlight the need for comprehensive approaches to achieve sustained effects on reducing population tobacco use. Given the focused New England population of this study, additional evaluation of the sustained impact of flavored tobacco sales restrictions is needed.

Full article available: http://www.rimed.org/rimedicaljournal/2026/06/2026-06-69-health-raut.pdf 

Introduction: Accessible, culturally tailored interventions are needed to address the high prevalence of cigarette smoking and the challenges to cessation experienced by sexual and gender minority (SGM) young adults. This study evaluated, in a randomized, controlled pilot trial, the acceptability, preliminary cessation-related outcomes, and impact on theory-based change processes of the SGM-tailored, Acceptance and Commitment Therapy (ACT)-based Empowered, Queer, Quitting, and Living (EQQUAL) digital program relative to the National Cancer Institute's Smokefree.gov program.

Methods: Participants were SGM young adults, aged 18-30, who smoked at least weekly. Participants were randomized 1:1 to either EQQUAL or Smokefree.gov, both of which included a web app and text messaging. Outcomes were assessed at 3 months post-randomization, and smoking abstinence was biochemically verified.

Results: The sample included 124 participants (n=63 in EQQUAL, n=61 in Smokefree.gov). On the primary acceptability outcomes, overall satisfaction was descriptively higher in the EQQUAL arm (68.8% vs. 60.0%; OR=1.17, 95% CI=0.50-2.78), and EQQUAL usability ratings exceeded the acceptable benchmark score of 68. The average number of EQQUAL digital sessions completed was 1.4 (of 6). On the primary cessation outcomes, biochemically verified 7-day point prevalence abstinence was higher in EQQUAL than Smokefree.gov (11.1% vs. 4.9%; OR=1.89, 95% CI=0.45-9.66). Change in readiness to quit and cigarettes per day were similar between arms, as were outcomes of theory-based change processes.

Conclusions: EQQUAL demonstrated potential benefits over Smokefree.gov on acceptability and cessation, albeit with a lack of robust effect on theory-based change processes. Increased engagement with the web-based portion of the program may be needed to improve outcomes.

Background: Tobacco cessation services delivered via quitlines increase the likelihood of smoking cessation. Integrated media communication campaigns are a critical channel for promoting quitlines. This study used real-world data to explore the effect of various tobacco control advertising campaign strategies on generating quitline self-referrals, including among high prevalence communities.

Methods: Monthly counts of self-referrals to the Victorian quitline were examined during periods of Quit Victoria advertising campaign activity and inactivity between January 2018 and December 2023. Campaigns varied by spend, pairing of motivational plus capacity-building messages or not, and extent of repeated airings over the previous 6 years. Negative binomial regression models examined associations between different advertising campaign strategies and self-referrals, adjusted for periods surrounding tobacco tax increases, and time.

Results: Self-referral rates accelerated as funding increased. These accelerating effects were particularly evident among high prevalence groups. Greater increases were observed when messages with different behavioural goals (eg, motivational and capacity-building) were delivered together, as well as during advertising campaign periods with messages that had aired at least once before in the previous 6 years.

Conclusions: Findings reinforce the importance of well-funded advertising campaigns, especially for high prevalence groups. Effects of previously delivered campaign messages can build with repeated use and so can be effectively re-used over an extended period. Pairing creative concepts with distinct behaviour change objectives may also drive a greater number of self-referrals to quitlines.

Introduction: State and local menthol cigarette bans are increasingly common, but strategies to boost their impact remain unclear. A campaign that encourages people who smoke menthol cigarettes to quit smoking altogether could amplify the benefits of bans. This study examined reactions to campaign messages in a situation where menthol cigarettes are no longer being sold among adults who smoke menthol cigarettes.

Methods: We conducted 6 semi-structured focus groups, each with 7-9 adults ages 21+ years, who smoked menthol cigarettes (n = 50). Four of the focus groups were with populations at higher menthol cigarette use (i.e., Black and lesbian, gay and bisexual adults). Participants shared reactions to 12 campaign messages that aimed to encourage quitting smoking (e.g., "You can start your quit journey today" and "You've got this!"). We conducted qualitative thematic analyses.

Results: Messages that used supportive language (e.g., "Every attempt counts") motivated participants to want to quit. Nuanced messages about money (reward vs. saving) and family (quit to spend time with family vs. quit for family), as well as encouragement to set small attainable goals also received positive reactions. Messages about mental health benefits of quitting received mixed feedback. Phrases like "quit smoking now" and mention of menthol cigarettes, as opposed to cigarettes in general, were described as punitive and negatively targeted.

Conclusions: Our study provides guidance for campaign developers seeking to encourage adults who smoke menthol cigarettes to quit smoking. Findings highlight the need for nuanced health communication to support quitting smoking among priority populations.

Introduction: U.S. military veterans have historically used tobacco at higher rates than the general population. Quitlines increase abstinence from tobacco use. The Veterans Health Administration (VHA) national telephone quitline, Quit VET, offers tobacco cessation counseling to veterans enrolled in VHA health care. An evaluation of Quit VET was conducted to evaluate the use and effectiveness of the Quit VET service.

Methods: A retrospective evaluation of the Quit VET telephone quitline was conducted among 7,013 veterans who were first time users and enrolled from January 1, 2019, through June 30, 2022. Evaluation was conducted 2024-2025. Of these, 4,311 (61.5%) veterans consented to longitudinal assessment for up to 1 year following completion of treatment. The primary outcome was self-reported, 30-day point prevalence abstinence at 6 months. Logistic regression was used to analyze associations between abstinence and veteran demographics, tobacco use, and treatment utilization.

Results: Veterans who used Quit VET were on average 56.4 (SD: 13.9) years old and mostly male (82.8%), White race (63.1%), and non-Hispanic ethnicity (84.6%). Cigarettes were the most common tobacco product used (77.2%) and 7.8% reported use of two or more products. Veterans completed 3.1 counseling sessions on average and 63.7% used cessation medication. After 6 months, 28.5% reported 30-day abstinence in a complete case analysis, 11.2% abstinence using an intent-to-treat analysis with a penalized imputation (i.e., missing=using tobacco). In an adjusted logistic regression model, tobacco use severity (number of cigarettes per day) was associated with decreased odds of abstinence at 3-,6-, and 12-months. Tobacco use treatment dose (number of counseling sessions completed) significantly increased likelihood of abstinence at all three endpoints. Self-reported use of tobacco cessation medication was associated with increased likelihood of self-reported abstinence at the 3- and 12-months endpoints.

Conclusions: Quit VET effectively supports abstinence in a real-world group of veterans using various tobacco products.